Evaluating the outcomes of routine level one ward care post major oesphago-gastric surgery

Abstract Background Oesophago-gastric cancer resections are complex operations. Many centres routinely manage patients in higher acuity settings such as surgical HDU, ITU or fast track beds. The UK has 2.4 critical care beds per 1000, compared to an average of 5 per 1000 across OECD-EU nations. The COVID-19 pandemic has also had a significant impact on availability of these beds. Patients in our unit are routinely admitted to a standard level one surgical bed with continuous non-invasive cardiac monitoring and nursing care ratio of 1 to 5. This has been in practice for over 10 years with good outcomes. Methods Consecutive major oesophago-gastric resections between April 2020 and March 2023 in a single tertiary unit were included. Patients were split into two groups: Patients who were admitted directly to the surgical ward or had a planned admission to ITU based on pre-operative assessment and routine Integrated Cardiopulmonary Exercise Testing (CPEX) outcomes were considered to have completed a standard pathway. The primary outcome was unplanned ITU admission rate. Secondary outcomes included: total length of stay (TLOS), 30- and 90-day mortality. Results 238 patients (187 M: 51 F) were identified with a median age of 69 (33 – 84 years). The resections performed were Ivor Lewis oesophago-gastrectomy (ILGO) (n=196, 81%), total/extended total (n=30), subtotal (n=10) or distal gastrectomy (n=3). 34 patients were admitted to ITU, of which 23 were unplanned (9.2%) and all had undergone an ILGO. The median TLOS and mortality data are outlined in Table 1, with <1% 30 and 90-day mortality for patients on the standard pathway. The median ITU length of stay was 5 days (1 – 48 days) with reasons for admission listed in Table 2. Conclusions Major oesophago-gastric cancer resections can be managed safely in the early post-operative period, outside of higher acuity care settings with good outcomes.